Since the death of George Floyd in May 2020, the United States has experienced a tumultuous, and often painful, reckoning with issues of racial justice and inequity. An intense national dialogue has ensued, bringing with it a rising awareness of the corrosive effects of systemic racism.
These issues are not new to health care, where uneven playing fields and stark disparities in health outcomes for minorities have been well documented for many years.
We know that people of color are more likely to die from preventable illnesses compared with people who are white, for example, or to struggle with particular chronic diseases — including diabetes and hypertension. The infant mortality rate for Black babies is much higher than for other populations, and Black mothers are more likely to die from complications during childbirth. Most recently, we have discovered that Black patients have been disproportionately impacted by COVID-19.
Statistics tell us that people of color in the United States are also more likely to experience delays in treatment, to lack affordable health insurance options and to reside in neighborhoods with shortages of primary care physicians.
In its groundbreaking 2003 report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” the Institute of Medicine (IOM) observed that “racial and ethnic disparities in healthcare occur in the context of broader historic and contemporary social and economic inequality, and evidence of persistent racial and ethnic discrimination in many sectors of American life.”
These problems have also pervaded the health care workforce, where studies have shown the presence of implicit bias against patients of color. Historical patterns of discrimination and bias have impacted minority enrollments in medical schools, leading to a physician workforce that still does not truly reflect the demographics of America.
The issues before us are longstanding and clearly documented. But what can we do about them? First comes a greater national consciousness, which we are experiencing now. With our recent racial reckoning comes the need for tangible action steps, which many U.S. institutions and organizations are taking.
The American Medical Association launched the AMA Center for Health Equity in 2019, for example, and hired its first Chief Health Equity Officer. Many other physician organizations have developed their own health-equity efforts, such as the American Academy of Family Physicians' Center for Diversity and Health Equity.
In the medical regulatory community, the FSMB has launched new efforts to raise awareness among its member boards, including hosting a major online symposium on the subject last year and forming a Workgroup on Diversity, Equity and Inclusion in Medical Regulation, chaired by Jeffrey D. Carter, MD, of the FSMB Board of Directors. The workgroup is preparing formal recommendations, and it will present an interim report to the FSMB House of Delegates for consideration during the FSMB’s Annual Meeting in New Orleans April 28–30.
Individual state medical boards are taking action as well: One notable example is the Washington Medical Commission, which has issued strong public statements and unveiled a multi-pronged action agenda addressing structural racism and implicit bias.
The Journal of Medical Regulation, too, has a responsibility to raise awareness of these issues, and to that end we are introducing a new series of articles in this edition. The first article, from authors David Johnson of the FSMB and Andrea Anderson, MD, of the FSMB Board of Directors, examines the concept of justice, equity, diversity and inclusion (JEDI) in medical regulation — starting with a close-up look at diversity in governance.
Other articles will follow, exploring these issues from multiple perspectives, raising important questions and offering recommendations for our professional community.
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